Follicular Unit Transplant (FUT)


Indications for FUT   |   Contraindications   |   FUT Harvest   |   Processing & Implanting

Standard Hair Transplant is frequently called Follicular Unit Transplantation (FUT) and is a name given to describe the most common method of modern surgical hair restoration.

Standard “Strip” Follicle Renewal

It refers to the “Strip” type of hair transplant where a narrow strip is used for the hair transfer and implantation process. Because some parts of your scalp are resistant to hair loss, hair follicles may be removed and placed in other  “barren” areas of the scalp. This meticulous process takes several hours and yields thousands of available follicles for transfer.

The surgical area is mended with a superficial stitch, healing within one to two weeks. Once detached from the body, Dr John E Frank, M.D. and his team finely process the band of scalp. Each hair follicle is isolated (every single one!) and refined prior to implanting each back into the balding areas. Once outside the body, the dissection process is highly technical and performed in a separate area by the John E. Frank MD Hair Restoration surgical assistants using high powered stereomicroscopes, razor-sharp knives, and other fine surgical instruments.

Finally isolated, each follicle is returned to the body where they are gently placed in a natural pattern replicating nature and begin healing and instinctively growing.  At John E Frank, MD, each step from design, harvest, handling and placement of the grafts is completed with the ultimate objective of obtaining the maximum density results.

Indications for FUT

The Strip Harvest has been the standard of care in transplant for the past 15 years.  When the final objective is the greatest density in the recipient area from the maximum number of grafts, the Strip Technique offers the best opportunity to achieve this.  The donor area is immediately camouflaged by the surrounding hair and is usually completely concealed by the time one leaves the doctors office.  Only a narrow, horizontal section of the back of the scalp is used rather than the broad, sweeping area for Follicular Extraction.  Finally, for the number of grafts harvested, the Strip is far more cost effective.  This may not be a factor initially, however over the course of utilizing the entire donor area for comprehensive follicle renewal, the Strip Technique has much greater cost efficiency.

Contraindications

Although not actually considered a contraindication, the most common reason people choose not to have this type of procedure is they are reluctant to have a permanent linear blemish in the back of their scalp; the single, and the punched out lesions of the Follicular Extraction seem more appealing.  A true, but very unusual contraindication to this method could occur in somebody who has such advanced baldness that the donor area is depleted of all the follicles.  Occasionally this becomes true after multiple surgical procedures of the scalp.

Of course as is the case in all Follicle Renewal procedures, the ongoing nature of hair loss must be considered while planning the procedure.

FUT Harvest

The final cosmetic result is the main factor for this determining graft numbers, it is still very essential to consider the finite donor follicles and also minimizing the donor blemish.  For most individuals, this should be a conservative estimate considering that hair loss is usually of an ongoing nature.  The clear objective is to camouflage any work done and this is assisted by keeping the donor hair long enough to cover the stitches. Having dense donor area and hair kept relatively long may allow for a more aggressive harvest, however it should not alone be relied upon when judging the extent of the harvest.
The main objective is to obtain the sufficient number of grafts while causing the least amount of trauma possible.  Dr John E Frank, M.D. observes the important plastic surgery principle is that in order to create the finest imperfection, one should attempt to minimize the tension across this or any wound.  For a hair transplant procedure, sizable procedures may be accomplished by utilizing a long, narrow strip (rather than a short, wider harvest).  The optimal situation is one where hair from the incumbent follicles are allowed to grow through the incision area and the basis of a Trichophytic closure and our proprietary “Double Trichophytic” technique.  This is a term borrowed from frontal scalp surgery and face/eyebrow lifting.

We have also learned that a fine Nylon suture creates the least discomfort while minimizing trauma. We strive to prevent any undermining of the skin as this invariably leads to a less than thin line scar. If this is necessary, then planning should be reviewed as it increases the risk of detectability, long term scarring, complications and usurping finite donor hair follicles. Optimal planning and utilizing the essential techniques of facial plastic surgery and tissue handling ensure results.

The local anesthesia we use is a combination of dilute, buffered Lidocaine followed by a more concentrated 2% Lidocaine to assure complete numbness of the area. With this formula administered slowly and gently, we yearn to keep any discomfort to a minimum.

Processing and Implanting

Once removed from the patient, under the direction of John E Frank, MD the follicle specialists sliver and isolate each graft using stereoscopic microscopes. Depending upon a number of unique characteristics, the follicles will be processed in different groupings and sizes.  Again, with the ultimate objective of delivering High Density Results, the grafts are handled with the utmost gentleness, while kept cold and moist.  The microscopic clefts are created and the grafts are placed with specific depth, orientation, angle, and slant.

Once removed from the patient, under the direction of John E Frank, MD the follicle specialists sliver and isolate each graft using stereoscopic microscopes. Depending upon a number of unique characteristics, the follicles will be processed in different groupings and sizes.  Again, with the ultimate objective of delivering High Density Results, the grafts are handled with the utmost gentleness, while kept cold and moist.  The microscopic clefts are created and the grafts are placed with specific depth, orientation, angle, and slant.